MS. JENNIFER WALLACE NPI 1356968440

NPI Information

NPI: 1356968440
Provider Name: MS. JENNIFER WALLACE
Classification: Technician/Technologist - 156F00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
2041 E 3RD DR
MESA, AZ
ZIP 85204
Phone: (480) 685-7530
Get Directions

MS. Jennifer Wallace is a technician technologist in Mesa, AZ. The provider is a broad category grouping different kinds of technologists and technicians. See individual definitions. MS. Jennifer Wallace NPI is 1356968440. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2041 E 3RD DR
MESA, AZ
ZIP 85204-401
Phone: (480) 685-7530

The NPI 1356968440 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS).

The enumeration date for this NPI number is 7/6/2020 and was last updated on 7/6/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	156F00000X	Technician/Technologist		$$$$$$$$$	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	272271586	OTHER	ARIZONA	EIN NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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